Comparison of patients with anterior wall healed myocardial infarction with and without exercise-induced ST-segment elevation.
To assess the extent of myocardial necrosis and ischemia in patients with anterior wall healed myocardial infarction depending on whether ST-segment elevation was present on precordial leads during exercise testing, 62 consecutive patients (49 men and 13 women, age [mean +/- SD] 56 +/- 11 years) with anterior wall infarcts were assessed with exercise technetium-99m (Tc-99m) methoxy-isobutyl-isonitrile single-photon emission computed tomography and quantification of the extent of necrosis and ischemia on polar maps: 22 patients had > or = 1 mm ST-segment elevation during exercise, and 40 did not. The extent of the necrosis in the anteroseptal (p = 0.001) and apical (p = 0.002) regions, the extent of ischemia in the lateral region (p = 0.003) on polar maps, and the frequency of ventricular aneurysm as shown by cardiac catheterization (p = 0.001) were significantly greater in patients with ST-segment elevation. In a multiple logistic regression model, both extent of necrosis in the anteroseptal region (odds ratio 10.8; 95% confidence interval 2.7 to 44.0) and extent of ischemia in the lateral region (odds ratio 7.25; 95% confidence interval 1.6 to 32.7) were associated with exercise-induced ST-segment elevation. These data suggest that ST-segment elevation in anterior infarctions is associated with wider necrosis in the anteroseptal and apical regions, with a wider extent of ischemia in the lateral region and a higher frequency of ventricular aneurysm. Consequently, it cannot be used as a marker of viability.
Candell-Riera
J
J
Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Santana-Boado
C
C
Armadans-Gil
L
L
Blanch
P
P
Aguadé
S
S
Castell
J
J
Vaqué-Rafart
J
J
Soler-Soler
J
J
D006328:Cardiac Catheterization; D003287:Contrast Media; D017023:Coronary Angiography; D004562:Electrocardiography / Q000592:standards; D005080:Exercise Test / Q000592:standards; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000175:diagnosis*; D009336:Necrosis; D016017:Odds Ratio; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000592:standards
D003287:Contrast Media; D017256:Technetium Tc 99m Sestamibi